Individual
DR. JERRY L NEELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1790 COMMERCE CENTER BLVD, FAIRBORN, OH 45324-6358
(937) 878-3941
(937) 878-3525
Mailing address
1790 COMMERCE CENTER BLVD, FAIRBORN, OH 45324-6358
(937) 878-3941
(937) 878-3525
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2797
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0311200
—
OH
01
—
310824134031
CARESOURCE
OH
01
—
NE0403232
MEDICARE LEGACY NUMBER
OH
Enumeration date
01/18/2007
Last updated
08/02/2011
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